Clinical Chem Explorer 6dA: Pancreas: Diagnostic Tests

Insulinoma, Cystic fibrosis, Zollinger-Ellison syndrome and Pancreatic Cysts. Strange names, but they have one thing in common, all of them involves the pancreas. Pancreas has two important functions in digestion a) first, it is responsible for the productions of enzymes to digest food and b) It produces hormones that control blood sugar. It makes insulin and glucagon, two important hormones that control blood sugar.

Now, imagine if laboratory tests are not discovered. How can you diagnose these Out-Of-This-World-Names-Of-Diseases. Thanks to those geniuses who discovered these machines and laboratory tests we are using now.

1) Endoscopic retrograde cholangiopancreatography (ERCP)

Who doesn't love eating? but did you know that every meal, bile enters the small intestine where it breaks down fats. Healthy gallbladder keeps bile from flowing, however, when the gallbladder becomes diseased, the flow slows. Chemicals which exist in the gallbladder solidify into either one large stone or several small ones.

ERCP is a procedure used to identify stone, tumors or narrowing in the bile ducts. This is the most reliable way of diagnosing and treating ductal stones. If gallstones are blocking the bile duct, they can also be removed during an ERCP.

The endoscope is inserted through the mouth.

It is passed through the esophagus and stomach until it reaches the duodenum.

A catheter is passed through the endoscope and inserted into the ducts that lead to the pancreas and gallbladder.

A special dye is injected into these ducts, and x-rays are taken. Dye is used to help the doctor see the structure of the common bile duct, other bile ducts, and the pancreatic duct on an X-ray.

2) Magnetic resonance cholangiopancreatography (MRCP)

Sounds familiar eh? I know you already know MRI, and MRCP is a kind of Magnetic Resonance Imaging (MRI) that is used to view the bile ducts and the pancreatic duct.
The name is a bit difficult to pronounce but it is a non-invasive method. It is performed when Endoscopic retrograde cholangiopancreatography (ERCP) has failed or cannot be done. It does not require contrast for imaging the pancreaticobiliary tree and may also be as good as contrast enhanced CT for assessing the severity and detecting pancreatic necrosis in patients with acute pancreatitis (Baker, S. 2004).

3) Abdominal CT with contrast enhancement

Contrast Enhance Computed Tomography is the gold standard for diagnosing pancreatic necrosis and peripancreatic collections. Contrast-enhance CT can also differentiated mild acute pancreatitis from severe acute pancreatitis. It is often performed between 3 and 10 days of the onset of symptoms to grade the severity of the disease (Baker, S. 2004).

4) Fecal Elastase Test (FET)

Fecal=Feces=Poopoo=Yuck! but we also have to test the poopoo becuase it contains the enzyme elastase. Elastase is an enzyme found in fluids produced by the pancreas. The fecal elastase test is another test of pancreas function.

"FET is a simple and accurate functional test for CP, and it is hardly influenced by extrapancreatic disorders or therapy with exogenous enzymes" (Gastroenterol, A.J. 1995).

The test measures the levels of elastase and is used to diagnose certain pancreas disorders related to not producing enough digestive enzymes.

5) Amylase and Lipase test

Being a medical technology student. We should embrace, love and be used to seeing blood. It is important to have the skills in collecting blood because there are a lot of tests that require blood samples. example of those tests are amylase and lipase test.
Amylase and lipase test are often ordered at the same time. These tests help in diagnosing and monitoring acute and chronic pancreatitis and other problems and disorders that involve the pancreas. The two tests may also be tested using urine sample.

For more information, watch this video:

http://www.youtube.com/watch?v=7FcJcmz-APM

Reference/s:

Baker, S. 2004. Diagnosis and Management of Acute Pancreatitis

http://cicm.org.au/journal/2004/march/Pancreatitis2.pdf

Gastroenterol. A.J. 1995. Fecal elastase test: evaluation of a new noninvasive pancreatic function test.

http://www.webmd.com/digestive-disorders/pancreas-function-tests

http://www.medicinenet.com/endoscopic_ultrasound/article.htm

http://pancreasfoundation.org/Docs/patient_info/CommonDisordersofthePancreas-Brochure.pdf

http://www.nlm.nih.gov/medlineplus/pancreaticdiseases.html

Photo credits:

http://gabrielrbrunoabioifes.wordpress.com/2011/02/13/pancreas-funcao-componentes-do-suco-pancreatico/